Finding a cure for our sick cities

There has been much debate about the legacy of the 2000 Sydney
Olympics, the first so-called "green Games". Would getting Sydney
on track as a healthy and sustainable city be an appropriate
Olympic legacy?

The discussion among health professionals about cities often
focuses on urban penalties - the disease epidemics associated with
rapid urbanisation during the industrial era in England, or
epidemics of obesity, depression and asthma associated with
urbanisation in the US, Australia and elsewhere.

Similarly, when environmental professionals discuss cities, they
often focus on consumption and measures such as the urban
footprint, the amount of land required to serve the resource and
waste management needs of the urban population. For Sydney, this is
about seven hectares for every resident. Cities can be seen as
voracious consumers and unhealthy places to live.

It need not be so. Cities can be healthy human habitat. During
the first half of the 20th century, Sydney's development was based
on a rail network. The location of employment, schools, hospitals,
shopping and services was aligned with public transport. With the
advent of the affordable motor vehicle in the middle of the
century, urban development decoupled from mass transit. The city
became more spread out and it was difficult to provide
infrastructure close to where everyone lived.

From the 1970s, we saw the emergence of large, stand-alone
shopping centres which drew shopping and services away from
residential areas and concentrated them in regional areas.

The areas of Sydney that developed after cars and then large
shopping centres became popular lack mass transit, local shopping
outlets and other services.

For Sydney to be healthy and sustainable this must change.

A check list for healthy and sustainable urban environments
includes: less than 500 metres (via paved footpath wide enough for
a wheelchair) to a bus, train or tram stop with regular services
(at least every 30 minutes, off peak); less than 500 metres to
shops; less than 500 metres to parks; less than 30 minutes by mass
transit to a range of employment, education, social and cultural
opportunities; safe walking and cycling paths to a primary and
secondary school; mix of housing types and prices, suitable
throughout the life cycle; housing built, or adapted, using
environmental principles; good outdoor and indoor air quality;
sense of community in the neighbourhood; tolerant and safe
environment.

How might we make the transition to a healthy and sustainable
city? Apart from addressing water, energy and environmental
building issues, there are additional priorities: investment in
infrastructure for mass transit and paved paths and cycleways,
balanced with investment in high-quality roads and motorways, along
with planning for the dispersal of shopping and services across
residential areas.

There is a role for large, stand-alone shopping centres, but
they should not be where we shop for daily grocery items, fruit and
vegetables, meat and fish, newspapers and the like. For such
businesses to flourish in neighbourhoods they need a market. This
can be achieved by locating them on transport routes and increasing
residential density.

For the sake of the health of future generations, governments
must invest profits from the resources boom in urban transport
infrastructure to support health on an environmentally sustainable
basis.

The Australian Government response to the Sustainable Cities
2025 inquiry is an important opportunity to move to a path for
healthy and sustainable cities.

In 2004, The Lancet published an editorial titled "The
Catastrophic Failure of Public Health" which argued for urgent
attention to be paid to urban planning for health. The health and
wellbeing of urban residents should be viewed as a central outcome
of urban development in our cities. More than 90 per cent of
Australians live in cities. We live these issues every day:
sedentary lives, traffic congestion, rising petrol costs and
increasing carbon dioxide emissions. In the next round of national
and state elections, we should require candidates to put these
issues at the top of the public policy agenda.

As with the successful Sydney Olympics, if we are to move Sydney
onto a path to be healthy and sustainable, we will need an
effective partnership between governments and the private sector.
Additionally, we will need effective engagement with the wider
Sydney community.

Together, we can deliver healthy and sustainable cities.

Professor Anthony Capon is a public health physician and a
visiting fellow with the National Centre for Epidemiology and
Population Health at the Australian National University. He is a
former director of public health with Sydney West Area Health
Service.